Print and Mail Direct Deposit Form or fill out the secure form below and submit online.
I hereby agree to the terms herein, certify that the depository information listed below is accurate and authorize Henry
Resources LLC (HR) to issue payments to me electronically via ACH. The undersigned agrees that HR is authorized to reverse
any electronic payments made in error to my account through the direct deposit program. I further warrant that I am a
holder on the account listed below. I also understand that I should allow up to 60 days for my enrollment to be processed
once received by HR.
I authorize HR to send my payment via Electronic Funds Transfer (Direct Deposit via ACH). Please deposit my payment in
PLEASE ATTACH A VOIDED CHECK AND PROVIDE THE FOLLOWING INFORMATION:
CHECK DETAIL DELIVERY (Please check mark one of the following :) (Please check mark one of the following :)
Note: IT IS YOUR RESPONSIBILITY TO KEEP US INFORMED OF ANY CHANGES IN BANKING INFORMATION OR EMAIL ADDRESS.
In the event that ACH is unavailable (e.g. due to closure or abandonment of an account or inaccurate account
information), HR will resume making payments to you via check.
3525 Andrews Hwy
Midland, TX 79703
Phone: (432) 694-3000
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